1
|
Sassorossi C, Congedo MT, Nachira D, Tabacco D, Chiappetta M, Evangelista J, di Gioia A, Di Resta V, Sorino C, Mondoni M, Leoncini F, Calabrese G, Napolitano AG, Nocera A, Lococo A, Margaritora S, Lococo F. Reducing Post-Operative Alveolo-Pleural Fistula by Applying PGA-Sheets (Neoveil) after Major Lung Resection: A Historical Case-Control Study. J Clin Med 2023; 12:jcm12072719. [PMID: 37048802 PMCID: PMC10095219 DOI: 10.3390/jcm12072719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Alveolo-pleural fistula remains a serious post-operative complication in lung cancer patients after surgery, which is associated with prolonged hospital stay and higher healthcare costs. The aim of this study is to evaluate the efficacy of a polyglycol acid (PGA)-sheet known as Neoveil in preventing post-operative air-leak in cases of detected intra-operative air-leak after lung resection. Between 11/2021 and 7/2022, a total of 329 non-small cell lung cancer (NSCLC) patients were surgically treated in two institutions. Major lung resections were performed in 251 cases. Among them, 44 patients with significant intra-operative air-leak at surgery were treated by reinforcing staple lines with Neoveil (study group). On the other hand, a historical group (selected by propensity score matched analysis) consisting of 44 lung cancer patients with significant intra-operative air leak treated by methods other than the application of sealant patches were considered as the control group. The presence of prolonged air-leak (primary endpoint), pleural drainage duration, hospital stay, and post-operative complication rates were evaluated. The results showed that prolonged air-leak (>5 days after surgery) was not observed in study group, while this event occurred in four patients (9.1%) in the control group. Additionally, a substantial reduction (despite not statistically significant) in the chest tube removal was noted in the study group with respect to the control group (3.5 vs. 4.5, p = 0.189). In addition, a significant decrease in hospital stay (4 vs. 6 days, p = 0.045) and a reduction in post-operative complications (2 vs. 10, p = 0.015) were observed in the study group when compared with the control group. Therefore, in cases associated with intra-operative air-leak after major lung resection, Neoveil was considered a safer and more effective aerostatic tool and represents a viable option during surgical procedures.
Collapse
Affiliation(s)
- Carolina Sassorossi
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Teresa Congedo
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Dania Nachira
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Diomira Tabacco
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Marco Chiappetta
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Jessica Evangelista
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Adele di Gioia
- Department of Thoracic Surgery, "Pierangeli" Hospital, 65124 Pescara, Italy
| | - Velia Di Resta
- Department of Thoracic Surgery, "Pierangeli" Hospital, 65124 Pescara, Italy
| | - Claudio Sorino
- Division of Pulmonology, Sant'Anna Hospital, 22020 San Fermo della Battaglia, Italy
- Faculty of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Michele Mondoni
- Respiratory Unit, Department of Health Sciences, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, 22020 Milan, Italy
| | - Fausto Leoncini
- Department of Pulmonology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Calabrese
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Adriana Nocera
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Achille Lococo
- Department of Thoracic Surgery, "Pierangeli" Hospital, 65124 Pescara, Italy
| | - Stefano Margaritora
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Filippo Lococo
- Departement of Thoracic Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| |
Collapse
|
2
|
Zhang J, Zhang Z, Liu D, Shao W, Feng H. A randomized trial of who is better at treating the incomplete pulmonary fissure between stapler and thulium laser. Minerva Surg 2021; 76:436-443. [PMID: 33829717 DOI: 10.23736/s2724-5691.21.08386-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of thulium laser in the treatment of interlobar fissures in lobectomy is not clear. We aim to evaluate the safety, effectiveness and economy of thulium laser in the treatment of incomplete interlobar fissure during lobectomy. METHODS A total of 76 patients were randomly divided into two groups: laser group and stapler group. The laser group was treated with thulium laser and the stapler group was treated with stapler. RESULTS Compared with stapler group, the laser group had a longer operation time, more postoperative drainage and lower operation cost while there was no significant difference in hospitalization time, postoperative air leakage time and chest tube duration. CONCLUSIONS Thulium laser is safe and effective in the treatment of incomplete interlobar fissure during lobectomy and can reduce the cost.
Collapse
Affiliation(s)
- Jun Zhang
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
| | - Deruo Liu
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China -
| | - Weipeng Shao
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, Peking University China-Japan Friendship, School of Clinical Medicine and China-Japan Friendship Hospital, Yinghua, Beijing, China
| |
Collapse
|
4
|
Chekan E, Whelan RL. Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:305-18. [PMID: 25246812 PMCID: PMC4168870 DOI: 10.2147/mder.s67338] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a “knowledge gap” that is potentially dangerous. The goal of this review is to present a framework for the study of device– tissue interactions and to initiate the process of “filling in” the knowledge gap via the available literature. Surgical staplers, which are continually being developed, are the focus of this piece. The integrity of the staple line, which depends on adequate tissue compression, is the primary factor in creating a stable anastomosis. This review focuses on published studies that evaluated the creation of stable anastomoses in bariatric, thoracic, and colorectal procedures. Understanding how staplers interact with target tissues is key to improving patient outcomes. It is clear from this review that each tissue type presents unique challenges. The thickness of each tissue varies as do the intrinsic biomechanical properties that determine the ideal compressive force and prefiring compression time for each tissue type. The correct staple height will vary depending on these tissue-specific properties and the tissue pathology. These studies reinforce the universal theme that compression, staple height, tissue thickness, tissue compressibility, and tissue type must all be considered by the surgeon prior to choosing a stapler and cartridge. The surgeon’s experience, therefore, is a critical factor. Educational programs need to be established to inform and update surgeons on the characteristics of each stapler. It is hoped that the framework presented in this review will facilitate this process.
Collapse
|